Mur Lura
SPEECH BY THE HON. ANTOINE MIFSUD BONNICI PARLIAMENTARY SECRETARY IN THE MINISTRY FOR SOCIAL POLICY, AT THE ZAMMIT CLAPP HOSPITAL DAY SYMPOSIUM ‘COLLABORATIVE PRACTICE – THE IMPACT ON OLDER PERSONS’ - LE MERIDIEN PHOENICIA. 29th September 2001
pr1409
28/09/2001
28/09/2001
| Monday next, is 1st October, the | International Day of Older Persons. On the 1st October 1998, at the launching of the International Year of Older Persons (1999), the General Secretary of the United Nations, Kofi Annan, had this to say: "We live in an age to which many labels have been attached; it is the past-cold war age; the past-industrial age; the age of the Internet; and the age of globilisation. Let me add one more today, for our time is also, undeniable, the age of longevity". |
| Longevity of life has to be reinforced by quality of | life otherwise life for the older people would be rendered artificial. An active policy to promote health among the elderly does not aim to keep a person alive irrespective of the quality of that life. One cannot condone the general tendency to attribute to ‘old age’ the variety of problems facing an older person without looking further. A short story can illustrate this point. A 94 year old gentleman who was experiencing pain in his left leg, went to see his physician and complained about this pain. The doctor told him: "Well, what do you expect when you are 94 years old"? To that the old man replied: "But, doctor, my right leg is 94 years old too, and it does not hurt". Health promotion policies should aim to add life to years by enabling as many persons as possible to remain healthy and active throughout the years of their life; to add health to life by reducing the occurrences of illness and accidents and toadd years to life by increasing the average life expectancy of the individual. |
Ageing is not a disease and cannot be prevented. Ageing is a process; being old depends on individual circumstances and wider environment, and the functional handicaps related to the aged begin to show gradually. Age treats every one differently. Some people remain active and productive at their age, others lose their capacity to function and become disabled. Quality of life in old age is influenced mainly by health factors. Recommendation 2 of the Vienna International Plan of Action states that: "The care of the elderly persons should go beyond disease orientation and should involve their total well-being, taking into account the inter-dependence of the physical, mental, social, spiritual and environmental factors. Health care should therefore involve the health and social sectors and the family in improving the quality of life ofolder persons. Health efforts, in particularly primary health care as a strategy, shouldbe directed at enabling the elderly to lead independent lives in their own family and community for as long as possible instead of being excluded and cut off from all activities of society". Although ageing is irreversible, many of the problems of old age can be prevented or ameliorated. Most of the problems of older people are not caused by the ageing process but by disease, loss of fitness and the social changes that accompany ageing.
| While age is a significant factor in the state of | health of the elderly, it is far from being the only one. Living conditions and life-styles also strongly influence the speed at which individuals age and the risk of being struck down by chronic disease. The age at which latter sets in, its seriousness and course, vary greatly according to education levels, occupation, the regularity of health checks and healthy living practices. A large proportion of the older persons, especially among the under 75’s, are often people in fairly good health who are independent, lucid and able to play a socially useful role. Physiological ageing does, however, lower individual resistance to health hazards and the incidence of diseases which particularly strike the elderly tends to increase at higher levels of the age scale. The diseases in question are above all major chronic complaints such as cardiovascular diseases, cancer, diabetes, diseases of the bones and joints, high blood pressure, respiratory complaints or age related mental disorders and psychiatric diseases. Also, old people frequently suffer from several diseases at the same time, the number of which increases with age. |
| In Gerontology and Geriatrics a range of disciplines | have contributions to make as team members in providing a comprehensive framework for addressing the potentially complicated issues that may face elderly persons with major health problems. No one health related discipline suffices alone as the clinical care of the older persons necessitate reliance on an integrated, inter-professional approach. Approach to the disabled elderly person must take account of the complexity of his or her situation. Assessments are correspondingly complex. Consideration must be given not only to the diagnoses but also to their practical consequences for the patient; observation must be given not only to impairments and deficits, but also to functions such as mobility, exercise tolerance and cognition. Evaluation of activities of daily living must be performed as well as the person’s function outside of institution. This complex approach requires a multi disciplinary team. |
| Geriatric hospital care implies the application of | the skills of Geriatric medicine which ensures a patient’s total condition to be assessed and, through the work of a multi-disciplinary team, a programme of treatment and rehabilitation is devised, which is geared to an early return to the community and to provision them of any necessary continuing care. All patients should receive in proper time any form of intensive treatment which they require, with a view to preventing complications and functional failure leading to permanent invalidity and premature death. In the delivery of health care to the elderly, the holistic approach should be emphasized. Elderly persons should be treated as such – as persons rather than cases – as whole beings rather than medical problems. The aged person is a ‘patient’ only a part of the day, and the rest of the time he is a ‘person’ facing a raft of social and emotional problems which bear upon his health condition. |
| In Gerontology, the essence of collaboration is the | betterment of the health of older persons. This interdisciplinary collaboration involves members of two or more disciplines working together in a supportive environment of mutual respect and ongoing information exchange for a common purpose. Such collaboration is an acknowledgment of the distinctiveness of the disciplines and the need for an integrated effort. Interdisciplinary collaboration means that each discipline retains its distinctive functions but the disciplines blend their unique qualities and abilities in an integrated effort. For this collaboration to be effective each member must understand and respect the contributions and competencies of the other members, be compatible with and effective in one’s own role, and assume responsibility for effective group function, including the development of a mutually supportive environment. In the field of Gerontology, interdisciplinary collaboration is not restricted to the disciplines within the health fields only. |
| The need to restore individuals, as early as | possible, to their own environment, capable of carrying out to their full potential the essential activities of daily living should be the ultimate goal of therapeutic care. Rehabilitation is an ongoing process from the minute any problem is found and must encompass an integrative approach of physical and mental health, social and economic support aspects. Rehabilitation is fundamental for the management of elderly persons. A wide spectrum of elderly persons suffering from chronic disabling diseases should be the primary beneficiaries of efficient and effective rehabilitation. It is also important for those elderly persons who may suffer from a focal reversible condition which may have a global impact on them. Adverse social circumstances, such as isolation and poverty, which may be encountered in the care of some older persons, also call for rehabilitation. Unfortunately some elderly persons who may face disabling conditions in some institutions may also need some degree of rehabilitation. Successful rehabilitation will require that notice is taken not only of what has happened to the ‘organism’ but also of the environment of the person. It is necessary not only to treat the damaged system but also the rest of the body; to take account of the psychological attitudes of patients and carers; and to manipulate the material environment to the patient’s advantage. Rehabilitation also involves mobilising a social support network, including both informed carers and statutory agencies, in the patient’s favour. |
| Rehabilitation, to be successful, essentially | requires the services of a qualified, dedicated, multi-disciplinary team, each member of which provides for an equally important area of assessment and care without which there cannot be full appraisal and restoration of a whole person within his or her environment. The team includes doctors, nurses, physiotherapists, occupational therapists, psychologists, social workers amongst other professionals. For a multi-disciplinary team to work successfully, the principle of rehabilitation must be grasped by all members. Goals must be agreed between the patient and the carers and the members of the team. The progress of the patient must be communicated between members of the team; so, too, must the progress of arrangements made for the patient. Multi-disciplinary case conferences in which team members meet, are therefore essential. Inter-professional rivalry must be avoided and there should be mutual trust and respect resulting in delegation of duties where appropriate. The role of doctors in a rehabilitation team is important. Their primary task is to get the medical diagnosis right and to institute appropriate medical treatment. They should constantly communicate with the patient and other members of the team and should ensure that there is a clear management plan and that standards are maintained. But they should not discard the opinion and expertise of the other members of the team. |
| Another principle of rehabilitation is progressive | patient care, where separate facilities and settings are made available for patients at different stages in their illnesses and treatment programmes. In a rehabilitation ward emphasis must be made on the assessment of function, on re-training mobility and activities of daily living, on the assessments of needs for aids-appliances and adaptations, on minimising support to encourage independence and on the involvement of carers. |
Ladies and Gentlemen,
| We have gathered here together at this Symposium with | the theme "Collaborative Practice – The Impact on Older Persons" organised to commemorate the 10th anniversary of the inauguration of Zammit Clapp Hospital as a unit specialising in Geriatric Medicine. During these 10 years I have been in the position to judge and evaluate the service given by Zammit Clapp Hospital from 2 different aspects – both as a politician who was assigned the specific post for the care of the elderly and also as a family doctor who could follow up a number of older persons who received treatment either as inpatients or outpatients at Zammit Clapp Hospital. In my opinion the best word I can use to describe this service is an ‘excellent’ service. This ‘excellence’ is based on 2 factors: first, the high level professional qualities of the multi-disciplinary team working at this hospital which is giving very good and satisfying results, and second, the humane approach to the older persons by all the personnel – an approach which respects the dignity of the older person. In this regard, I feel in duty bound to express publicly my grateful thanks, also on behalf of so many elderly persons who have benefited from this service, to all the staff of Zammit Clapp Hospital. A big ‘thank you’ to all the medical staff – the two consultants, Dr Fiorini, who has been on board since the inauguration of this hospital, and Dr Bugeja, recently appointed as a consultant, supported by qualified and highly motivated doctors; to all members of the diverse disciplines – nurses, therapists, psychologists, social workers, etc. etc; to all the various employees who are all contributing in different manners towards the attainment of such good results; to the Chairman and Management Board who are responsible for the efficient administration of this hospital. |
| While looking backwards at these past ten years of | service given by Zammit Clapp Hospital with satisfaction, we must look forward in the future for the coming decade. During the coming ten years, Zammit Clapp Hospital will certainly help us to achieve the goal which we are striving for – a Maltese society which will be an inclusive society where the older person plays a prominent part as this society is also a ‘Society for All Ages’. |
Thank you.
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